<?php global $base_url;
$root = $base_url."/".path_to_theme();
?>
<?php 
unset($form['submit']['#value']);
unset($form['name']['#title']);
unset($form['name']['#description']);
$form['submit']['#attributes'] = array('class'=>"forgot_btn");
$form['name']['#attributes'] = array('class'=>"signup_input");
$form['mobile']['#attributes'] = array('class'=>"signup_input");
?>
<div class="main_login" id="forgot_pwd">

<img src="<?php print $root."/images/forgot_image.gif";?>" width="188px" height="29px">
<div>
<p style="margin-top:30px; "><span class="input_fld_name" style="width:160px; margin:-2px;">My mobile number is</span>
<?php
unset($form['mobile']['#title']);
print drupal_render($form['mobile']);?></p>
<p style="margin-top:10px;"><span class="input_fld_name" style="width:160px; margin:-2px;">My email ID is</span><?php print drupal_render($form['name']);?></p>
<p><span class="input_fld_name" style="width:100px;"></span><?php print drupal_render($form['submit']);?></span></p>
</div>
		<!--Hidden values-->
        <div style="display:none">
        <?php print drupal_render($form);?>
        </div>
        
</div>